Abstract 19644: A Biocompatible Light-Activated Adhesive for Intra- and Extracardiac Applications in Acquired and Congenital Heart Disease

Abstract

Background: There is a clinical need for alternative methods for tissue to tissue and device to tissue attachments in cardiovascular surgery. Tissue adhesives offer a potential solution. However, commercially available tissue adhesives are associated with poor control over adhesion and low adhesive strength, especially in the presence of blood and under dynamic conditions. Thus, we developed a light-activated adhesive, poly(glycerol-co-sebacate) acrylate (PGSA) and evaluated its effectiveness for interventions in acquired and congenital heart disease. Methods and Results: The adhesive strength of PGSA and cyanoacrylate (CA) coated patches was evaluated in pull-off tests using fresh myocardial tissue. In the presence of blood, adhesive strength was 1.4 ± 0.6 N/cm2 and 1.6 ± 0.3 N/cm2 for PGSA and CA coated patches, respectively. In addition, the adhesive strength did not decrease in case the PGSA coated patch was immersed in a blood-filled glass dish for 5 minutes before the measurement. To evaluate the ability of PGSA to close cardiac defects, transmural left ventricular (LV) wall defects (d=2 mm) were created in a chronic in vivo rat model and closed with a biocompatible patch and PGSA (n=26). Closure with sutures only or CA was used as a control. Animals were sacrificed after 7, 28 and 60 days. Closure was successful in over 90% of the cases for all three groups. Histology revealed a good integration of the patch with minimal inflammatory reaction. In contrast, closure with CA exhibited a pronounced inflammatory response. Echocardiography reveals preservation of LV function for PGSA whereas closure with sutures led to impaired regional contractile function. In addition, surgically created incisions in the aorta (d=1 mm, n=1) and the carotid artery (d=2 mm, n=4) were successfully closed with only PGSA without bleeding and blood flow was confirmed in an acute in vivo pig model (n=3). Histology revealed intact endothelium at the curing site and no thrombi. Conclusions: Cardiovascular defects can be successfully closed with a light activated tissue adhesive in a chronic animal model. Longterm evaluation indicates superiority over closure with sutures or CA. PGSA is a promising adhesive for a variety of cardiovascular applications including devices.